Punwani Vishal V, Ong Eugene, Hii Michael W
Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
BMJ Case Rep. 2015 Sep 9;2015:bcr2015211711. doi: 10.1136/bcr-2015-211711.
A 47-year-old woman presented to a tertiary emergency department with an 8-day history of odynophagia, a 4 cm swelling on her left neck and intermittent fevers. Shortly following her birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck demonstrated several large diverticula within her interposition graft at the level of the cervical vertebrae. A colocutaneous fistula was identified between the colon and left neck, with an associated abscess. The patient received intravenous meropenem followed by abscess drainage. A high output fistula developed at the drainage site, and the patient required intravenous fluids and stoma placement to manage fluid discharge. She left the hospital after a 17-day stay. At 6-month follow-up, the wound was erythematous, but the patient was otherwise well. We believe that this is the first reported case of diverticular disease arising in what was originally neonatal colon interposed for oesophageal atresia at birth.
一名47岁女性因吞咽痛8天、左侧颈部有一个4厘米的肿物及间歇性发热就诊于一家三级急诊科。她出生后不久,先天性食管闭锁接受了结肠间置移植手术治疗。颈部增强CT显示在颈椎水平的间置移植结肠内有几个大憩室。在结肠与左侧颈部之间发现了一个结肠皮肤瘘,并伴有脓肿。患者接受了静脉注射美罗培南治疗,随后进行了脓肿引流。引流部位出现了高流量瘘,患者需要静脉补液并放置造口以处理液体排出。住院17天后出院。在6个月的随访中,伤口发红,但患者其他情况良好。我们认为这是首例报道的因出生时为治疗食管闭锁而间置的新生儿结肠发生憩室病的病例。